Many people worked together to develop this wellness guide.

AAAAAcknowledgmentscknowledgmentscknowledgmentscknowledgmentscknowledgments

This book is dedicated to all the Plains Indian Nations ofNorth Dakota and those people who have been fighting thegood fight against a relatively new threat – diabetes. Our hopeis that this handbook helps each person on his or her journeyto wellness. Our prayer is that the Creator will provide thosewho are living with diabetes, the strength and determinationneeded to walk the path of wellness.

DedicationDedicationDedicationDedicationDedication

Technical and Cultural Consultants: Medical Review Consultants:

Connie Fox Dr. Zane Rising SunJohn Buckley Dr. Biron BakerJohn Eagle ShieldAnne WadsworthLogan Davis

Original Art and Illustrations: Other Contributing Entities:

Lorri Ann Two Bulls Standing Rock Diabetes ProgramCarey Bitner Spirit Lake Diabetes Program

Finding the Balance is a joint project between representativesfrom: Standing Rock Nation, Spirit Lake Nation, TurtleMountain Band of Chippewa, and the Mandan, Hidatsa andArikara Nation, KAT Productions, the North DakotaDepartment of Health Diabetes Prevention and ControlProgram, and the American Diabetes Association – NorthDakota Affiliate. This publication was supported byCooperative Agreement U32/CCU813559-06 from the Centersfor Disease Control and Prevention. Its contents are solely theresponsibility of the authors and do not necessarily representthe official views of the Centers for Disease Control andPrevention.

Eagle Photograph:

Michael Kramer

ContContContContContentsentsentsentsentsTable of

Exercise ....................... 18

Our People Today ................... 4

Circle of Life ............................ 6

Body ........................................... 7

Mind ....................................... 25

Heart ........................................ 29

Spirit ........................................ 34

Family ...................................... 36

Appendix................................. 40

Diet .............................. 14

Kids Corner ................. 37

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Our People Today

Diabetes is a serious health problem among our people. It is sowidespread that many fear they will get it and die early deaths fromthe complications. Too many of our people think there is no wayto prevent diabetes or its complications. These mistaken beliefs arelife threatening and must stop!

It is true that more and more of our people are getting diabetes. Infact, we as a people have more diabetes than any other race withinthe United States.

For many generations, our people found wellness withinthe circle of life. This handbook will provide an under-standing of the relationship between a walk in wellnessand the circle of life. We will look at total wellness as itrelates to body, mind, heart (or emotions) and spirit. Wewill address those issues that can help someone withdiabetes maintain a healthy walk. There is hope. You canhelp yourself, your family, and your community. It allstarts with a few simple steps.

Prevalence of diabetes by race/ethnicity in people 20 years or older

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Complications such as kidney disease, blindness and amputationsare on the rise. These complications remain a serious concern.

Diabetes however, doesn’t need to devastate our lives. There is hopeand wellness is possible. With a healthy walk we can avoid thesecomplications and possibly avoid diabetes altogether.

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The circle of life has beenimportant to our people forgenerations. Understandingthe circle is a sacred gift thatcan be used to guide usthrough life. Within thecircle, healing is found.

The Circle of Life

Much is found within the circle:

directions – east, south, west and north,

seasons – spring, summer, autumn and winter,

elements – fire, water, earth and air,

stages of life – childhood, youth, adulthood and elderly,

body – body, mind, heart (or emotions) and spirit.

Striving for balance within the circle by attending to your body,mind, heart (or emotions) and spirit will result in wellness.

Life is a journey of self-discovery and growth toward wholeness.

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It is important to understand yourphysical body and how diabetes canaffect your walk in wellness. The bodywas given to us by the Creator and weneed to take care of it. What we take incan strengthen or weaken the body. Ahealthy physical body is needed toachieve a balanced walk within thecircle of life. Remember… physicalhealth is a process taken one step at atime throughout each stage of life.Recognize your successes today andbuild on continued wellness tomorrow.

Moving Toward a Healthy Body

The Body

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Knowing Your Body

In a healthy body, the food we eat is broken down into sugar.Our body uses this sugar for energy. Insulin (a hormone madein the pancreas) helps move the sugar into our cells. Diabetesresults when a body doesn’t make enough insulin or cannot useit well, causing sugar to build up in the blood. As a result, thebody does not function well.

What is Diabetes?

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TTTTTypypypypype 1 diabete 1 diabete 1 diabete 1 diabete 1 diabeteseseseses

once called “juvenile diabetes”usually found in children and young adultspancreas no longer produces insulinrequires insulin shots every dayaffects an estimated 5-10 percent of those with diabetes

TTTTTypypypypype 2 diabete 2 diabete 2 diabete 2 diabete 2 diabetesesesesesonce called “adult onset diabetes”usually begins in adulthoodhealthy diet plus exercise can sometimescontrol itsome insulin is produced, but the body cannotuse it wellusually treated with pills or oral insulin,sometimes insulin shots

» affects an estimated 90-95 percent of those with diabetesis delayed or prevented with proper diet and exercise

There are two main types of diabetes.

Ask your doctor or health care provider if you do not know whattype of diabetes you have.

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Symptoms of diabetes:

frequent thirstfrequent urinationblurry visionunexplained weight lossfrequent infectionsslow healing woundsvery dry skinfrequently feeling tiredvomitingloss of feeling or tingling in the feet

Symptoms

You are more likely to get diabetes if you

have a family history of it, don’t exercise, are overweight, abuse alcohol, are American Indian.

If diagnosed with diabetes, you can prevent and delaycomplications. Keep your blood sugar levels as near to normal aspossible. If you have good control of your blood sugar levels, youcan live a long and healthy life. Appendix A, “Managing BloodSugar” describes the steps to monitor your blood sugar levels.

An A1C tA1C tA1C tA1C tA1C testestestestest is the best way to find out if your blood sugar

is under control. You should have an A1C test at least twice a year.See your doctor for this test.

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Pay close attention to your body. A healthy walk starts withspecial care of your eyes, mouth, heart, and kidneys. Payspecial attention to your body when illness strikes.

Regular visits to the eye doctor can identifyany potential problems.

Eyes

Brush and floss twice a day. Regularcheckups can identify and treat problemswith your teeth and gums.

Dental

If you notice a change in vision or see rings, spots or flashinglights, see your doctor right away. Don’t delay.

If you notice that your gums are red, sore, swollen, shrinking orbleeding, see your dentist right away.

!

!

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Regular visits with your doctor can identifyany problems.

Heart and blood vessels

dizziness sudden sight loss slurred speech

chest pain swollen ankles shortness of breath

numbness or weakness in one arm or leg

cramping in buttocks, thighs or calves during physicalactivity

Do not ignore these warning signs. Contact your health careprovider immediately.!

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Good bloodsugar andblood pressurecan prevent ordelay kidneydisease.

Kidneys

Your body was created to work together in balance.With diabetes it is important to take special stepsto keep that balance. When you are sick with acold, flu, or other illness, take special care of yourbody. Appendix B provides sick day guidelines tohelp you when you are sick.

Illness

cloudy or bloody urine

burning or pain with urination

frequent or urgent urination

back pain

chills or fever

Do not ignore these warning signs. Contact yourhealth care provider immediately.!

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A Healthy Balance

Our ancestors ate a healthy diet and consumed large amountsof water.

The traditional diet consisted of thenatural foods from the land such as

lean meats (buffalo, elk,and deer),

vegetables (corn,breadroot, and beans),

fruits (chokecherries, Juneberries and plums).

Foods from the Past

Foods were prepared to create naturally lean, low-fatitems. For example, pemmican was made by pounding driedmeat into slivers, then adding fat and berries to create a tasty,high-energy food.

We can learn much from our ancestors. Our people were healthyand there was no diabetes.

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carbohydrates fats protein

water vitamins minerals

Today’s diet has changed from that of our ancestors. Conveniencerather than good nutrition has become the priority. For many ofour people, fast foods have become the main component of dailydiets. Unfortunately, many of these foods are unhealthy for ourbodies. Many believe these foods have played a role in the rise ofdiabetes in our people. By changing from unhealthy foods tonutritious, good-tasting foods, good health will result.

The amount of food you need every day depends on your age, bodysize, activity level, and whether you are male or female.

Our Foods Today

Remember our bodies need six essential nutrients:

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66 + ( )+

( )-( )4.36 x how muchyou weigh 4.32 x height

in inches4.7 x age

66 + ( )+

( )-( )6.22 x how much youweigh 12.7 x height

in inches6.8 x age

Carbohydrates 55-60% Protein 12 – 15% Fats 30%

Figure out your daily calorie needs at resting state*

Males

Females

*The Harris-Benedict Equation

Dailycalories at

resting

For example:

2000 calories x 55% = 1100 calories2000 calories x 15% = 300 calories2000 calories x 30% = 600 calories

Divide your daily calories between

Counting Calories

○

○

○ ○

○

○

= 66 + (6.22 x 220) + (12.7 x 74) - (6.8 x 55) = 2000 calories

For example: Weight: 220 lbs. Height: 74” Age: 55 yrs Male

○

○

○

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Varieties of fresh fruits and vegetables(five or more servings per day)

Varieties of grain products, including wholegrains

Lean meats

Fish (twice a week), such as salmon

Low fat foods

Few high calorie foods such as sweets, soda, andgizzards

10 eight-ounce glasses of water per day

Healthy Food Choices

As we change our eating habits, we balance our nutritionand make progress toward the goal of physical wellness.

fried hamburgers French fries soda pop

breaded chicken burgers milk shakes chips

candy gizzards cheese sticks

hot dogs sports drinks potato wedges

Avoid unhealthy convenience foods

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Our ancestors werevery busy. Althoughtheir lives weredifficult andstrenuous at times,activity kept themfit. Securing shelterand food consumedmost of their days.

Activities from the Past

When the chores werecompleted, ourancestors celebratedwith dancing,competitions, andgames that expendedlots of energy andmotion. All activities,both leisure and work,helped the tribes notonly to survive, butalso to keep membershealthy and fit.

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The new generations have kept very little of the traditionalhealthy lifestyle that their ancestors followed. Life no longerrequires strenuous activityto secure shelter or food.

Changing our inactivelifestyle and adding exerciseis important to findingphysical wellness.

Activities Today

Remember that the life goal is physicalwellness…and the path to wellness is a journey. Take it slowly. Takethe stairs instead of the elevator. Remember to park far from thedoor instead of choosing the closest spot.

Physical activity is anything you do that requires

exertion and maintains or develops fitness. Take it slowly at first,increasing activity as you go along.

Fun Activities

Everyone should aim to build at least30 minutes of moderate activity intoeach day, at least five days a week, toensure a healthy walk.

walk jog traditional dancegarden play sports bikehike swim aerobic exercise

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Great news…the evidence is mounting! You can do a lot to delayor even prevent diabetes in your future. The Diabetes Preven-tion Program set out to see if lifestyle changes could affect therising rates of diabetes. They studied more than 3,000 adults,171 of them being Native Americans. The results are encourag-ing. Lifestyle changes can definitely prevent or delay diabetes,even if you have a family history of it.

The people in the study found exercise and healthy food had apositive impact in their lives. Losing a small amount of weight(seven to ten pounds) and increasing activity levels preventeddiabetes from developing in many of the participants. Furtherstudies are needed to determine how long diabetes can bedelayed, but every disease-free year is one more yearof not dealing withcomplications.

Take this encouragingnews!! Make changesin what you eat. Getmotivated. Start withsmall steps…eat less frybread…take a walk….stopdrinking pop…you cando it.

Diabetes Prevention Program

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Use as few as possible

Lean meatsare best

Eat more of these

Eat 5-9fruits andvegetablesper day.

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Understanding the carbohydrate and fat content of foods is askill you need in order to eat healthier meals. The nutrition factspanel on food labels gives useful information.

Why Read Food Labels?

If you eat morethan one serving,remember tomultiply thenumber of gramsby the number ofservings.

This number tellshow many grams offat there are in oneserving. Ask yourdoctor and dietitianhow many grams offat you should havein a day.

Discuss calorie needswith your doctor anddietitian to have anindividualized meal plandeveloped just for you.

This number tellshow many grams ofcarbohydrates thereare in one serving.Ask your doctorand dietitian howmany grams ofcarbohydrates youshould have in aday.

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Do keep your feet clean and dry.Do wear shoes that fit well with goodsupport, low heels and room to wiggleyour toes.Do wear clean cotton or wool socks,changed daily.Do have your feet examined every timeyou visit your doctor.Do check your shoes for gravel or looseobjects before wearing them.Don’t use lotion between your toes; use itonly on the tops and bottoms of your feet tokeep them softDon’t soak your feet in water.Don’t go barefoot.

Caring for your FeetGood foot care is needed for a healthy walk.Loss of feeling and poor circulation will leadto foot injuries, infections, ulcers and,ultimately, amputation. Avoid these problemswith control of blood sugar levels.

Do’s and Don’ts of Foot care

Take off yourshoes andsocks, anddon’t hesitateto ask for afoot check.

red spots

ingrown toenails flaking or dry skin

cuts or calluses hot or cold feet (skinshould be warm)

A daily foot check will prevent complications. Check both feetentirely. (Use a mirror if necessary.) Have someone help you ifyou can’t check your feet yourself.

Watch closely for these warning signs:

!

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Visiting your DoctorScheduled visits with your health care team are important to ahealthy walk. See your physician at the first signs of diabetes.

A complete medical history

A thorough medical examination

Appropriate laboratory tests

An initial plan to manage your diabetes

What to expect on your first visit

Appendix C provides anAnnual Wellness Checklist.Remember to askquestions until you have agood understanding ofyour management plan.

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Moving Toward a Healthy Mind

Mental wellness replaces despair with hope and wisdom.

It is important to understand yourmental being and how diabetes canaffect your walk in wellness. A healthymental state is needed to achieve abalanced walk within the circle of life.Remember… educating oneself is aprocess. Take one step at a timethroughout each stage of life. As yougrow and succeed, you can tell yourstory to others and share your wisdom.

The Mind

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your family and friends,

primary care doctor,

nurse educator or certified diabetes educator,

registered dietitian,

eye doctor,

mental health worker,

podiatrist (foot doctor),

dentist,

exercise expert.

You are the team leader. Involve all members as much as possible.Ask questions, share information, seek help, and live well.

Learning for You; Sharing Hope with Others

Learning to manage diabetes is a continuous process. Remember,YOU are the most important member of your diabetes team. Manyothers will work with you, support you, and participate in youreducation. When developing your diabetes management team,consider the following people:

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I will die from diabetes complications.

Studies show complications can be prevented.

We must destroy the common myths that are found with diabetes.

Myth:

Knowledge will awaken the power within you.

I can wash away the extra sugar in my blood by drinkingmore water.

You cannot “wash away” extra sugar from your blood.

Insulin is a cure for diabetes.

There is no cure for diabetes. Insulin controls your blood sugar levels,allowing for a healthy life.

I can no longer eat sugar now that I have diabetes.

With careful planning, small amounts of sugar can replace some ofthe carbohydrates that are usually eaten at a meal.

I won’t get diabetes because no one has it in my family.

Diabetes can occur in people with no family history of diabetes.

I will get diabetes because someone in my family hasdiabetes.

Although you are at greater risk for diabetes, healthy lifestyle habits willdecrease your chances of getting the disease.

I am borderline diabetic.

There is no such thing as a person with borderline diabetes.You either have it or you don’t.

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Find a calm, peaceful, or joyful place to meditate.

Sit in a comfortable position using good posture.

Close your eyes.

Take several deep cleansing breaths.

Clear your mind of distractions –be patient, this takes time.

Focus on a positive word orphrase, visualize a peaceful spot,or concentrate on a time you felthappy or hopeful.

Start slowly – two or threeminutes and work your way up.

Calming the Stress StormMeditation relaxes your body. Daily meditation relieves stress.Studies indicate that stress can actually cause the onset ofdiabetes.

The goal of meditation is a peaceful and calm state of mind.

Remember…the goal is to relaxyour mind and body.

Simple steps to follow:

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It is important to understand your emotionalbeing and how diabetes can affect your walkin wellness. A peaceful emotional being isneeded to achieve a balanced walk within thecircle of life. An unhealthy emotional state isa roadblock to wellness. We as a people tendto hold our feelings inside. This is dangerousand can make us sick. We need to learn todeal with emotions and let them out. Wemust take charge of those emotions that areout of control in our lives. Then peace andemotional wellness will prevail.

Moving Toward a Healthy Heart

Emotions (or Your Feelings)

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Drinking alcohol

Taking drugs

Smoking and/or using smokeless tobacco

Overeating

Excessive sleeping

Neglecting personal needs.

Stress RelieversStress occurs when the body adjusts to an event. Stress can havea positive or negative effect in our lives, helping or hinderingus, depending on how we react to it. When stress is negative, ittriggers the release of certain body hormones, which can causeheart attack, stroke, high blood pressure, and infections. Insomeone with diabetes, stress also increases blood sugar levels.You must control stress if you want to live a healthy life.

Finding the source of the stress.

When experiencing stress, breathing slowly and deeply.

Taking brief walks – fresh air is cleansing.

Singing – in your car…in the shower…or at home.

Playing with your pets.

Starting a hobby.

Laughing with friends.

Sharing your feelings with someone.

Healthy ways to relieve stress:

Unhealthy ways to relieve stress:

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Drinking alcohol puts you in immediate danger. Heavy drinkingdamages your liver. It also causes nerve damage, leading toblindness and loss of feeling in your arms or legs. Do not drinkalcohol.

Chemical StressTobacco, alcohol, and drugs are harmful to your body.

Smoking puts people who have diabetes at greater risk of healthcomplications, such as

kidney disease, liver damage, heart disease.

A person using illegal drugs is four times more likely to have aheart attack; in addition, drugs affect your blood pressure and heartrate, resulting in complications. Illegal drugs used by someone withdiabetes can be fatal.

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Don’t use tobacco, alcohol, or drugs.

Find replacement activities such as meditation andrelaxation.

Rally friends and family for support.

Remember

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Avoid the Depression TrapDepression for those with diabetes is not wellunderstood. Diabetes is a difficult disease tolive with 24 hours every day. If propersupport and treatment are not available,depression can result.

The good news – depression is very treatable.With the proper medication, support, and/orcounseling, you will soon feel better.

Twenty percentto thirtypercent ofpeople whohave diabetesalso havedepression.

Contact a physician or counselor for depression screening ifany of the following occur regularly over a period of two ormore weeks:

a loss of interest or pleasure in things you normally like,

less sexual interest or desire,

weight gain or loss,

sleeping a lot more or a good deal less,

energy loss, feeling tired all the time,

feeling worthless or more guilty than usual,

less able to concentrate or make decisions,

more irritable or anxious than usual,

many thoughts of death, not just the fear of death,

frequent thoughts of suicide.

If you are depressed and having thoughts ofsuicide, ask for help immediately.

!

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Moving Toward a Healthy Spirit

The SpiritIt is important to understand the spiritualpart of life and how diabetes can affect yourwalk in wellness. The circle of life teaches thatharmony within your spirit is needed toachieve a balanced walk. Seeking aconnection to the Creator is central toachieving total harmony in your walk. Prayeris important. The spiritual journey will revealthe wisdom, courage and determination thatour Creator offers for a walk in wellness.

3535353535

lowers your blood pressure, heart rate, and breathing rate,

improves healing,

decreases heart attacks, headaches, and anxiety,

provides calm in times of stress.

A faith journey

Start each day in prayer.

Find a quiet place with few distractions.

Focus on your connection with the Creator.

As you grow in your faith journey, increase the amount of time you spend in prayer and reflection.

Developing Your Spiritual WalkA spiritual journey is like every other; it occurs one step at a time.Do not underestimate the healing power of a spiritual walk.

A 1995 study from Dartmouth College in Hanover, NewHampshire, revealed the power of prayer. The study found thatpeople undergoing open-heart surgery were 12 times less likely todie if they had a spiritual connection. We can learn much fromtheir experience.

Simple steps to spiritual wellness

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The circle of life shows us our walk is notalone. It teaches that each person is unique,but also connected to others – our families,friends, and community members. Thisconnection provides support and guidanceduring life’s journey.

Family, friends, and community providewisdom and support which strengthens youwhen you are weak, uplifts you when you aresad, and challenges you when you makeunhealthy choices. Seek guidance from yourelders and the Creator. It is important toteach the youth to be well in body, mind,heart and spirit. Together we stand strong.

Moving Toward a Healthy Family

The Family

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Kids In ActionLet people ask youquestions about diabetes.

Invite family to your schoolto talk about their diabetes.

Get your school involved indiabetes prevention.

Tell friends to eatnutritious foods and to getactive for good health.

Get others to join you inexercise activities.

Run, walk, jump, dance,bike, and swim.

Kids Corner

With healthy foods and, lots of fun exercise,you can become a role model among yourfamily and friends.

If you have diabetes, walk a healthy path and lead othersto wellness. If you don’t have diabetes, be a model to yourfamily and friends.

The circle of life has beenimportant to our people for generations. Within the circle wefind guidance for the whole person – body, mind, feelings,and spirit. Start your life journey on the road to good health.Learn the message of the circle from your elders and begin ahealthy journey.

You have the power within you.

KidsOnly!

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Good for 1 trip tothe swimming pool

Good for a30-minute exercise

of my choice

Give these coupons as a gift to yourparent, grandparent, brother, sister,or friend. You can have funtogether and be healthy.

Good for a20-minute bike ride

Good for a10-minute walk

Good for 1 gameof basketball

Good for 1 tripto the playground

Reward Someone You Love

Cut ondotted lines

3939393939

Families in actionPlan nutritious meals together.

Grocery shop together.

Agree to get rid ofunhealthy food at familygatherings.

Cook together.

Exercise together.

Give up smoking anddrinking together.

Share feelings and thechallenges of the day.

Be accountable to eachother.

Pray together.

Supporting the whole family

Our journey to wellness is better when we walk together. Youcan lead your family into health by supporting their healthwalk.

Make sure your testing instrument is clean andworking properly.

Wash your hands with warm water and drythem well.

Massage your hands and fingers to get the bloodflowing into your finger.

Prick your finger with a lancet device. Work fromthe base of the finger to squeeze a small amount ofblood onto the test strip.

Place the strip into your testing instrument.

After three to five seconds, your blood sugarlevel will appear.

You should record your blood sugar value. Manytypes of diabetes record books are available.

Dispose of the strip and lancet properly.

Managing Blood Sugar

Appendix A

The American Diabetes Association guidelinesfor blood sugars are as follows:

80-120 pre-meal whole blood range goal,

100-140 bedtime goal,

Less than 70 – low blood sugar.

low blood sugar

If you have diabetes, you should check your blood sugarregularly. It’s easy. Get into the habit of regular checks.

Speak to your health careprofessional about howoften you should test yoursugar levels and about theproper medication doseneeded to manage yourdiabetes.

Note: There are many different kinds of glucose monitors, and yourdoctor will advise you regarding testing goals. The testinginstructions and blood glucose values are not intended to overrideyour doctor’s or instrument manufacturer’s instructions.

Sick Day ReferenceAppendix B

These guidelines can be used for a minor illness. They can alsobe used when you have a dental procedure and cannot chew.

Before you become ill:1. Train family members or friends in blood sugar monitoring

or other support you will need when you are sick.

2. Make a sick day box containing thefollowing:

pain reliever,

antacids,

medication to relieve vomiting (see your physician),

medicine to control diarrhea,

thermometer.

Be sure to talk to your diabetes care team about sick days – theymay have other guidelines for you.

your urine ketone levels rise,

ketones are in your urine for more than 12 hours,

your blood sugar levels are greater than 200 mg/dl,

you are vomiting or have other unusual symptoms,

your temperature is more than 101.5 degrees Fahrenheit oryou have a fever for more than 24 hours.

! Call your doctor if

1. Keep eating – even if you can’t eat solid food, you must stillhave the same number of carbohydrates (whether liquid orsolid). (See Carbohydrate Content of Liquids and Soft Foods.)Discuss with your doctor the best way to do this.

2. Keep taking your diabetes medicine.You may need to change the dose –consult with your doctor. Bloodsugar levels may shift due to thestress of the illness and change indiet.

3. Drink plenty of liquids to preventdehydration – try to drink one-halfto one cup of non-caloric liquidevery hour. Diet pop, water or teas(without sugar) are good choices.

4. Keep a record of your illness. Usethe “Sick Day Record” on thefollowing page.

While you are sick:

Sick Day RecordArea toaddress

How often tocheck

Results

Weight Daily

Date Pounds

TemperatureEvery morning

and night

KetonesEvery 4 hours or eachtime you pass urine

Time Ketones

MedicineAs directed by yourhealth care provider

Liquid intake Every evening

Date Ounces

Time Dose

Blood sugar Every 4 hours

Time Level

A.M. P.M.

CARBOHYDRATE CONTENT OF LIQUIDSAND SOFT FOODS

Grams ofCarbohydrates

Non-diet soft drink ½ cup 15

Orange juice ½ cup 15

Apple or pineapple juice ½ cup 15

Grape or prune juice a cup 15

Milk 1 cup 12

Ice cream, vanilla ½ cup 15

Cereal, cooked ½ cup 15

Gelatin, regular ½ cup 20

Sherbet ½ cup 30

Popsicle 1 cup 24

Sugar 1 tsp. 4

Coffee, tea, bouillon, broth 1 cup 0

Soup, thin creamy 1 cup 15

Soup, thick chunky 1 cup 20

Cream soup, made with water 1 cup 15

Cream soup, made with milk 1 cup 27

Pudding, regular ½ cup 30

Pudding, sugar-free ½ cup 15

Yogurt, plain or artificially sweetened 1 cup 12

Yogurt, fruit flavored 1 cup 40

Broth 1 cup 0

Jell-O, regular ½ cup 20

7-Up, regular 1 cup (8 oz) 30

Ice cream ½ cup 10

Tea 1 cup 0

Food Item Amount

Annual Wellness ChecklistHave your health care provider do these tests and services for you atleast one time per year.

Have your health care provider do these tests and services for youeach visit.

Tests and services Dates and Results

Blood pressure

Blood glucose

A1C

Weight

Foot check

Eye exam (dilated)

Tests and services Dates and Results

Pneumonia shot(once or twice in life)

Flu shot (every year)

Foot exam (complete)

Urine protein

HDL cholesterol

LDL cholesterol

Total cholesterol

Blood creatinine

Triglycerides

Appendix c

American Association of Diabetes EducatorsWeb site: www.aadenet.org

1-800-TEAM-UP-4

American Diabetes AssociationWeb site: www.diabetes.org

1-800-DIABETES

American Diabetes Association315 North 4th Street

Grand Forks, ND 582031-888-DIABETES

American Podiatric Medical AssociationWeb site: www.apma.org

1-800-FOOTCARE

Centers for Disease Control and PreventionDivision of Diabetes TranslationWeb site: www.cdc.gov/diabetes

1-877-232-3422

Juvenile Diabetes Research Foundation InternationalWeb site: www.jdrf.org

1-800-533-CURE

National Diabetes Education ProgramWeb site: www.ndep.nih.gov

1-800-438-5383

National Institute of Diabetes and Digestive and Kidney DiseasesNational Diabetes Information Clearinghouse (NDIC)

Web site: www.niddk.nih.gov1-800-860-8747

Appendix D

Resources for further reading

Diabetes is a disease that impacts the spiritual, mental,physical, and emotional dimensions of an individual’s life. Copingwith this disease is difficult for the person with diabetes and theirfamily support system. Many of the beliefs and opinions thatpeople have about wellness and diabetes will affect how theymanage their diabetes. It is well to look at it as “management”because there is no cure for diabetes. This might be furtheraffected by their beliefs about what it means to be male or a female.These are called gender beliefs.

Gender beliefs are important because they help youunderstand how to act or be in social situations. They are a part ofour self-image, self-esteem, and self-concept. Some gender beliefsare outdated and do not work in today’s society because the reasonsthey existed are not relevant today.

An example is the way some people believe men are supposedto be strong, don’t cry, are in charge, tough, successful, active, anddominant over women. Some people think women are supposed tobe polite, emotional, nurturing, pretty, submissive, dependent, sexy,take care of the kids and be available to men. Many femalesdiscount their own feelings if they need to care for loved ones,cannot take the time to, or do not think they deserve this right.

It is hard for those without diabetes to understand, but aperson with diabetes might not accept medical help if they cannotaccept their disease. The loss of health is more difficult than itsounds because of the old beliefs about men can take it, are strong,and don’t have any feelings. Many females discount their ownfeelings if they need to care for loved ones, cannot take the time, ordo not think they deserve this right. They may never get to worktheir way through the loss of good health.

Appendix E

A Gender Beliefs & Diabetes Self-CareStanding Rock Diabetes Program

For those who think they are supposed to be strong, whenyou are diagnosed with diabetes, they think they are weak and notmuch of a man. It may be why medical care is not sought until itis a crisis. Many females are also taught to be responsible for theirfamilies. This means they sometimes put their health care needslast. For a person with diabetes, waiting until it seems right to getmedical care, can cause complications that can be prevented.

Both males and females can have a hard time managing theirdiabetes and appear as if they don’t care to their families. Thismight be a cause of misunderstanding with their family supportsystems and the medical staff.

We all know it is easier to look at someone else’s issues ratherthan our own, it is easier to be too busy for self-care, and it is easierto avoid pain rather than to seek pleasure. This is why exercise andproper nutrition is not popular. It is easier to look for an easier,softer way.

These are broad generalizations and life is not that simple.To make a point though, it is helpful to see them in the extremeform. These unhelpful beliefs exist in our society and caninfluence how we approach our own personal health. Genderbeliefs can get in the way of wellness if they are taken to theextreme. Remember before we are male or female, we are allspiritual beings and have spiritual teachings about being humanbeings first. Remember only you can take care of yourself!